Provider Demographics
NPI:1962454827
Name:WOOD, BOBBY W JR (OD)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:W
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 STONEWALL HL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1667
Mailing Address - Country:US
Mailing Address - Phone:830-591-7595
Mailing Address - Fax:830-278-1995
Practice Address - Street 1:3040 E MAIN ST
Practice Address - Street 2:SUITE Q
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6424
Practice Address - Country:US
Practice Address - Phone:210-222-2154
Practice Address - Fax:210-222-2154
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5954TG152W00000X
NC1519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0985380001OtherPALMETTO
TXU47458Medicare UPIN
TX0985380001OtherPALMETTO